薦腸關節定量核醫掃描之診斷價值

Diagnostic Value of Quantitative Sacroiliac Scintigraphy

為探討99m Tc薦腸關節定量核醫掃描可否幫助脊椎關節病變的診斷，我們研究56位僵直性脊椎炎，12位萊持氏症候群，6位乾癬性關節炎，及16位疑及早期脊椎關節病變等病患；另以32位從未罹患背痛的健康人作為對照組；並檢查27位全身性紅斑狼瘡，21位類風濕關節炎，及各有1位X光見有單側薦腸關節炎的痛風，與左膝結核性關節炎病患。我們發現99mTc薦腸關節定量核醫掃描非為一特異性檢查，然而其高敏感性卻可幫助吾人對薦腸關節炎作早期診斷，早期關節炎時，多數病患之薦腸指數(SI index)昇高，而於重度薦腸關節炎時則降低。本研究發現早期的薦腸關節炎可侵犯薦腸關節的滑膜部份與韌帶部份，但以滑膜部份之發炎較劇。萊特氏症候群病患若有薦腸關節侵犯，其兩側薦腸薦骨比值(SI/ S ratio)常為不對稱性增高。當兩側差異大於0.55時，可能要慮及此病。顯然地99m Tc薦腸關節定量核醫掃描將有助於早期脊椎關節病變之診斷。

To assess the diagnostic value of quantitative sacroiliac scintigraphy in seronegative spondyloarthropathies, 56 patients with definite ankylosiog spondylitis (AS), 12 patients with Reiter's syndrome, 6 patients with psoriatic arthritis, 16 patients with highly suspicious early AS, and 27 patients with SLE, 21 patients with RA were studied. The uptake was markedly elevated in patients with active AS, highly suspicious early AS, Reiter's syndrome, psoriasis, and also in a number of patients with RA, and SLE. The uptake was normal or even low in patients with advanced AS. Both ligamentous and synovial portion of sacroiliac joints could be affected, and the uptake was higher in the latter in early sacroilitis. Our data suggest that Reiter's syndrome may be considered when the difference between the SI/ S ratios of both sides is greater than 0.55. Quantitative scintigraphy appears to be helpful in the early diagnosis of spondyloarthropathy and evaluation of asymmetric sacroiliitis of Reiter's syndrome.